Organization
EAST TENNESSEE BRAIN & SPINE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. WILES MD (PRESIDENT)
(423) 232-8301
Entity
Organization
Contact information
Practice address
701 MED TECH PKWY, SUITE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
TN
363AS0400X
Surgical Physician Assistant
—
TN
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366452914
—
VA
05
—
3721061
—
TN
01
—
4069221
BLUE CROSS/BLUE SHIELD
TN
05
—
5903904
—
NC
05
—
7100132610
—
KY
Enumeration date
08/08/2006
Last updated
06/06/2012
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